Devita, Hellman, and Rosenberg's Cancer

LWBK1006-48 LWW-Govindan-Review December 12, 2011 20:53

592 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Question 48.9. A 45-year-old African American man with locally advanced adenocarci-

noma of the lung is currently undergoing concurrent chemotherapy with

radiation. On one regular office visit, the patient reports taking Kava

extracts (60 mg/d) to relieve his anxiety and insomnia. He tells you that

it helped his symptoms very well and asks you if it is safe to continue tak-

ing this medicine. Which of the following responses is TRUE regarding

Kava extracts?

A. There is no scientific evidence supporting the efficacy of Kava extracts

in relieving anxiety and insomnia in patients with cancer.

B. Significantly reduces chemotherapy agents in the blood levels.

C. Increases the toxicity of chemotherapy

D. Kava extracts may cause severe hepatotoxicity.

Question 48.10. A 50-year-old woman with metastatic breast cancer completed her fourth

cycle of single-agent docetaxel 4 days ago. She now presents to the emer-

gency department with severe nausea, vomiting, and diarrhea. Her lab-

oratory test results reveal severe neutropenia with a total white blood

cell (WBC) count of 400 cells/mm^3 and severe thrombocytopenia with

a platelet count of 30,000 mm^3. She is admitted to the hospital, and

with appropriate supportive care she recovers well from the episode and

presents to your clinic for further chemotherapy. On careful history tak-

ing, she reveals that after her last cycle of chemotherapy she started taking

grapefruit juice to relieve her heartburn symptoms from chemotherapy.

Which of the following is the appropriate next step in her care?

A. Discontinue grapefruit juice and continue chemotherapy at scheduled

dose

B. Discontinue grapefruit juice and delay the next dose of chemotherapy

C. Continue taking grapefruit juice and resume chemotherapy with a

25% dose reduction

D. Resume chemotherapy at the current dose as scheduled

Question 48.11. A 59-year-old man is undergoing chemotherapy for pancreatic cancer

and has constipation. He is interested in using a herbal treatment for

constipation. Which of the following agents is a natural laxative?

A. Ispaghula

B. Flaxseed

C. Aloe vera

D. All of the above

Question 48.12. Which of the following herbal supplements increases bleeding risk, and

should be avoided in a patient with gastric cancer who is taking Coumadin

for deep venous thrombosis?

A. Licorice

B. Red clover

C. Alfalfa

D. All of the above